ONE-STAGE LAPAROSCOPIC PELVIC LYMPHADENECTOMY AND RADICAL PERINEAL PROSTATECTOMY

Laparoscopic pelvic lymph node dissection is currently an accepted pro cedure for staging adenocarcinoma of the prostate. To assess the feasi bility and efficacy of performing laparoscopic pelvic lymph node disse ction and radical perineal prostatectomy during the same anesthesia, w e retrospectively analyzed 98 patients with clinically localized adeno carcinoma of the prostate who were candidates for radical prostatectom y. Of the patients 12 (12%) underwent laparoscopic pelvic lymph node d issection only since they had metastatic disease to the pelvic lymph n odes on frozen section evaluation (the Gleason pathological grade was 2 to 4 in 2 patients, 5 to 7 in 8 and 8 in 2). Of the remaining 86 pat ients who underwent radical perineal prostatectomy for definitive mana gement 76 (88%) underwent 1-stage radical perineal prostatectomy immed iately after laparoscopic pelvic lymph node dissection, while 10 (12%) in the initial stages of our series underwent delayed perineal prosta tectomy following laparoscopic pelvic lymph node dissection (2-stage). The average postoperative hospital stay in the 1-stage group was 3.11 days, yet 19 (25%) patients were discharged from the hospital within 48 hours and another 39 (51%) within 72 hours. Thus, 76% of the patien ts were discharged from the hospital within 72 hours of laparoscopic p elvic lymph node dissection and radical perineal prostatectomy. The ad vent of laparoscopic pelvic lymph node dissection and radical perineal prostatectomy has found a resurgence at our institutions, with its lo wer morbidity rate and more rapid return to normal activity for these patients. Based on our results, we recommend laparoscopic pelvic lymph node dissection followed by radical perineal prostatectomy as a 1-sta ge treatment option for localized adenocarcinoma of the prostate.